pg48-52_Sanders:William&MaryMagazineTemplate 6/3/09 11:14 AM Page 48 HOUSE CALLS

With Her New York Times Magazine Column, Dr. Lisa Sanders ’79 Visits Thousands of Homes Each Week

BY BRITTNEY PESCATORE ’07

Lisa Sanders ’79 is very different from the star of House, M.D. , the Dr. television show that she helped inspire and for which she now serves as medical advisor. Not only is she much nicer than the famously ornery Dr. House, she also has a very different approach to the practice of medicine.

In the pilot episode of the show, House sends some young doctors to been writing a monthly column called “Diagnosis” for the New York

break into a patient’s home to try to find clues about what was wrong Times Magazine . Her column typically focuses on specific stories where N A

with the patient. a patient’s unusual problem at first confounds doctors until someone M R E

“I’ve never broken into my patient’s house,” says Sanders. “Not once. starts thinking creatively and the correct diagnosis is made. M A

I’ve never even been tempted to.” Sanders says that it can be “tricky” to translate technical medical H N O

Sanders, an assistant professor in internal medicine at the Yale information into everyday language. D : O

School of Medicine, does have something in common with the fictional “I think of myself as a good communicator, but I have to say my edi - T O H

doctor. Like House, she is fascinated by diagnoses. Since 2002, she has tor often will send me back a note, ‘What is this?’” she says. “I’ll think P

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“I’ve never broken into my patient’s house. Not once. I’ve never even been tempted to.”

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it’s a word that everybody understands and knows, because medicine is side,” she says. “So when I got to med school and saw all these incredi - a language as much as it is a body of knowledge.” bly dramatic, compelling, intellectually stimulating stories, I’d come Despite the occasional lapse into obscure medical jargon, Sanders is home and tell these stories at the dinner table.” as much a writer as she is a doctor. She majored in English at the Col - Her dinnertime stories were not easily forgotten. lege and then went on to a career in broadcast journalism, working for “One of the people who [used to hear the stories] eventually got a job ABC’s Good Morning America for a few years before moving on to CBS. at the Times ,” says Sanders. “He called one day and said: ‘You know She stayed at CBS until the first Gulf War broke out and everyone those stories you used to tell at the dining room table all the time? I was required to work 18-hour shifts, which interfered with her ability to think it’d be interesting to have them in the newspaper.’” His original go to pre-med classes. At that point, she had lost interest in journalism plan was to go out and find a professional writer. after coming to the realization that the news business was undergoing a “But I guess no one saw them the way that I did,” said Sanders. Her fundamental change toward a more profit-driven enterprise. Medicine editor suggested that she write the column herself and she agreed. “He had always been something that interested her, and so she enrolled in said, ‘That’s great; your deadline is in four days.’” the two-year Post-Baccalaureate Premedical Program at Columbia The column caught the attention of Paul Attanasio, one of the exec - University. In the fall of 1992, at the age of 36, she entered the Yale utive producers of House . Sanders says he called her up and told her School of Medicine as the oldest member of her class. he was working on a show about diagnoses that she might be interest -

Sanders did her internship and residency at Yale’s internal medicine ed in. She later found out that the show was inspired at least in part by N A

program. She was made chief resident in 2000. her column. M R E

During that time, Sanders grew interested in the diagnostic process Each episode of House , much like Sanders’ column, tends to revolve M A

that doctors undergo when treating a patient; she couldn’t help but around unusual medical problems that the characters, led by Dr. H N O

share that interest with other people. House, work to diagnose in time to properly treat the patients. As med - D : O

“What I didn’t know about medicine is that the most interesting stuff ical advisor for the show, Sanders sends the producers ideas for weird T O H

that goes on is figuring things out. I didn’t really know this from the out - diagnoses when something interesting crosses her desk. She also P

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“So when I got to med school and saw all these incredibly dramatic, compelling, intellectually stimulating stories, I’d come home and tell these stories at the dinner table.”

Dr. Lisa Sanders ’79 with fellow medical personnel, including Dr. Tracy Rabin ’97 (center)

reviews each script a few weeks before they start shooting to make “But no one listened, because he was just a kid,” says Sanders. sure things make medical sense. For entertainment’s sake, her advice Although a doctor eventually made the correct diagnosis, the appro - doesn’t always get taken. priate treatment had been delayed. What he had was a rare infection, “Sometimes things are more important than being medically accu - Lemierre’s disease, which had almost disappeared but is now making a rate,” she says. “I don’t think anybody would mistake House for reality, comeback. What he didn’t have, as he knew from the beginning, was so I’m just not too worried.” strep. The boy did not recover in time and died. The story is sad, but One of the least accurate things about the show is Dr. House’s uncan - Sanders says it’s one of her favorites because it represents an impor - ny ability to make every diagnosis before the episode’s hour is up, sav - tant problem in medicine: “Doctors just don’t believe patients.” ing most of his fictional patients in the nick of time. Sanders does not share Dr. House’s view on patient input. In the Despite Dr. House’s amazing success rate, Sanders emphasizes that show’s pilot episode, Dr. House shows no interest in talking to the it is actually “ridiculously frequent” for a doctor to send a patient home patients, claiming that they lie too much. Dr. Sanders has a very differ - after treatment without ever really figuring out what made them sick in ent take. the first place. “I think it’s the most important thing we do as doctors,” she says. “The technology of treating a patient now is so incredibly good that “The most important information that’s transmitted from doctor to there are often times when somebody will come in sick-as-stink, you patient comes from the patient. Certainly it’s true that patients are like - treat based on what you see, they go home and you never really have a ly to lie to House, but that has to do with who House is.” total answer,” she says. “Sometimes they come back because you only In case there’s any doubt that Sanders is committed to hearing partially treated them, but often they’re fine and you never really know.” patients’ accounts of their illnesses, the title of her forthcoming book Not all of Sanders’ columns have as satisfying an ending as a House sends the message home: Every Patient Tells a Story: Medical Mysteries episode. In one of her favorite columns, she tells the story of a 17-year - and the Art of Diagnosis . The book is the newest project that Sanders old boy who had a sore throat and kept insisting that it felt like some - has added to her busy schedule of clinical teaching, column writing, thing other than strep throat. show advising, and parenting her two daughters, ages 11 and 14.

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“[The book] takes you backstage and to doctor’s water fountains, “Doctors are fundamentally storytellers, but the story we tell always where we talk and think about patients,” says Sanders of Every Patient has the exact same format, and that’s the format I imitate and repro - Tells a Story , which comes out this fall. duce in my column and book,” she says. The format begins by looking at Only about a third of the book draws from material already dis - the patient’s story; next, it discusses the physical exam and then moves cussed in her columns; the rest is new information that she’s been on to the diagnostic testing. The last part focuses on how doctors think. researching over the past few years. She says that writing a book is a Unlike her columns, the book focuses a lot more on where things go different kind of challenge from writing a column. Then there’s the wrong in the diagnostic process. She says that, in her columns, she added difficulty of finding the time. often glosses over the fact that somewhere in the story there was a doc - “I get up at 4 a.m., write until 7 a.m. when the kids get up,” she says. tor who made a mistake. The book focuses on what causes diagnostic “One and a half days a week are just my writing days, after I take my error, looking mostly at failure in data collection. kids to school.” But the rest of the week, says Sanders, she’s busy writ - Sanders’ emphasis on getting the right diagnosis is where she and ing her Times column and teaching at Yale. Dr. House can always agree. Still, Sanders maintains that the tasks of writing her column, author - “If something doesn’t make sense to him, he’s all over it. And I think ing a book, and even practicing medicine aren’t all that dissimilar. that’s what we all hope for in our doctors.”

DIAGNOSIS: Forgetting Everything By Lisa Sanders ’79, M.D. Originally published in the Nov. 11, 2007, New York Times Magazine

1. Symptoms his doctor’s office. From there they were sent to Brigham and The flashing icon announced that an instant message had arrived. Women’s Hospital in Boston. The young woman at her computer at work clicked on it eagerly. It For part 2 ( Investigation ) and part 3 ( Resolution ), visit was from her fiancé. Silly boy. She’d only left him an hour ago. www.wmalumni.com/?summer_09. For more “Diagnosis,” visit “Something’s wrong,” the message read. www.nytimes.com/pages/magazine. “What do you mean?” she shot back. “I can’t remember anything,” he wrote. “Like I can’t tell you what we did this weekend.” The young woman’s heart began to race. Her fiancé had been strangely forgetful lately. She thought maybe he was just tired. He’d been having trouble sleeping for a couple months — ever since they’d moved in together. The previous weekend they went to New York to plan their wedding. He had been excited when they set up the trip, but once there he seemed unusually quiet and hesitant. “When is our wedding date?” she quizzed.“Can you tell me that?” “No :(” “Call the doctor. Do it now. Tell them this is an emergency.” Over the next half-hour the 27-year-old man put in three calls to his doctor’s office, but each time, he would forget what they told him by the time he messaged his fiancée. Separated by miles of Interstate and several suburbs, the young woman was frantic. Finally, at her insistence, the man, now terrified, asked a friend to R

take him to the closest hospital. E B I A few hours later, her cellphone rang. At last. He was being dis - E R T charged, he told her. The emergency-room doctor thought his S T R

memory problems were caused by Ambien, the sleeping pill he was A : C

taking. The doctor said the symptoms would probably improve if B N

he stopped taking the medication. Probably. F O Y

“Don’t go anywhere,” the young woman instructed. “I’ll pick you S E

A scene from House, M.D., the show that was inspired by Dr. Sanders’ T

up. I’m going to take you to your doctor.” She found him wandering R

New York Times Magazine column. Pictured above (clockwise from bot - U the street near the hospital, uncertain about why he was there and O tom left) Jennifer Morrison, Jesse Spencer, Lisa Edelstein, Robert Sean C O

even what her name was. She hustled him into the car and drove to Leonard, Omar Epps and Hugh Laurie (center) as Dr. Gregory House. T O H P

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